自发性低颅压综合征伴脑静脉系统血栓形成及硬膜下血肿诊治经验分享:一例报告

目的 报告1例自发性低颅压综合征伴脑静脉系统血栓形成及硬膜下血肿病例,总结其临床表现及影像学特征,以提高临床医师的诊断与鉴别诊断能力,以及对相关并发症的认知程度.方法 与结果 男性患者,56岁,亚急性至慢性病程,以体位性头痛发病,呈渐进性加重并伴右侧肢体麻木无力.影像学检查呈弥漫性硬脑膜强化、双侧慢性硬膜下血肿、脑静脉系统血栓形成表现,经补液、抗凝、机械取栓、溶栓治疗后血栓明显减少;由于出血倾向持续增加、硬膜下血肿扩大,经停用抗凝药、开颅血肿清除术得以控制病情,硬膜下血肿体积缩小.出院后3个月,头部MRI显示脑静脉窦基本无充盈缺损,显影程度明显提高;患者体位性头痛消失,未遗留局灶性神经功能障碍...

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Published in中国现代神经疾病杂志 Vol. 22; no. 6; pp. 486 - 492
Main Authors 李红梅, 刘玲春, 杨顺宇, 杨瑞晗, 刘达, 孟强
Format Journal Article
LanguageChinese
Published 650032 昆明理工大学附属医院云南省第一人民医院神经内科 01.06.2022
Subjects
机械溶栓
颅内低压
颅内血栓形成
脑静脉
血肿,硬膜下,颅内
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ISSN1672-6731
DOI10.3969/j.issn.1672-6731.2022.06.008

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Abstract 目的 报告1例自发性低颅压综合征伴脑静脉系统血栓形成及硬膜下血肿病例,总结其临床表现及影像学特征,以提高临床医师的诊断与鉴别诊断能力,以及对相关并发症的认知程度.方法 与结果 男性患者,56岁,亚急性至慢性病程,以体位性头痛发病,呈渐进性加重并伴右侧肢体麻木无力.影像学检查呈弥漫性硬脑膜强化、双侧慢性硬膜下血肿、脑静脉系统血栓形成表现,经补液、抗凝、机械取栓、溶栓治疗后血栓明显减少;由于出血倾向持续增加、硬膜下血肿扩大,经停用抗凝药、开颅血肿清除术得以控制病情,硬膜下血肿体积缩小.出院后3个月,头部MRI显示脑静脉窦基本无充盈缺损,显影程度明显提高;患者体位性头痛消失,未遗留局灶性神经功能障碍.结论 自发性低颅压综合征伴脑静脉系统血栓形成及硬膜下血肿患者通过补液、抗凝及血管内治疗虽可使脑静脉窦血栓所诱发的症状与体征有所好转,但这些措施无法遏制硬膜下血肿的进一步扩大,尽早发现脑脊液漏并及时修补漏口,更有利于痊愈.
AbstractList 目的 报告1例自发性低颅压综合征伴脑静脉系统血栓形成及硬膜下血肿病例,总结其临床表现及影像学特征,以提高临床医师的诊断与鉴别诊断能力,以及对相关并发症的认知程度.方法 与结果 男性患者,56岁,亚急性至慢性病程,以体位性头痛发病,呈渐进性加重并伴右侧肢体麻木无力.影像学检查呈弥漫性硬脑膜强化、双侧慢性硬膜下血肿、脑静脉系统血栓形成表现,经补液、抗凝、机械取栓、溶栓治疗后血栓明显减少;由于出血倾向持续增加、硬膜下血肿扩大,经停用抗凝药、开颅血肿清除术得以控制病情,硬膜下血肿体积缩小.出院后3个月,头部MRI显示脑静脉窦基本无充盈缺损,显影程度明显提高;患者体位性头痛消失,未遗留局灶性神经功能障碍.结论 自发性低颅压综合征伴脑静脉系统血栓形成及硬膜下血肿患者通过补液、抗凝及血管内治疗虽可使脑静脉窦血栓所诱发的症状与体征有所好转,但这些措施无法遏制硬膜下血肿的进一步扩大,尽早发现脑脊液漏并及时修补漏口,更有利于痊愈.
Author 孟强
刘玲春
李红梅
杨顺宇
杨瑞晗
刘达
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LIU Da
MENG Qiang
LI Hong-mei
LIU Ling-chun
YANG Rui-han
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Keywords 机械溶栓
颅内低压
颅内血栓形成
脑静脉
血肿,硬膜下,颅内
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Title 自发性低颅压综合征伴脑静脉系统血栓形成及硬膜下血肿诊治经验分享:一例报告
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